Disagreement of energy and macronutrient intakes estimated from a food frequency questionnaire and 3-day diet record in girls 4 to 9 years of age

Reliability and Validity Estimate of the Pro-Inflammatory/Anti-Inflammatory Food Intake Score in South American Pediatric Population: SAYCARE Study

Chronic low-grade inflammation may be associated with the development of chronic non-communicable diseases in young populations, often lasting to adulthood. Studies show that the diet is related to chronic inflammation. The Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) is an indicator that measures the inflammatory potential of the diet, with the help of validated tools that assess food consumption. The validation of tools that assess inflammatory dietary patterns in young populations to produce valid and reliable results is essential to guide disease prevention strategies for adulthood.

METHODS

This study aimed to estimate the Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) in children and adolescents in South America and to test its reliability and validity using a food frequency questionnaire (FFQ) and an inflammatory biomarker. This work consists of a validation study in a sample of children and adolescents conducted in South America (SAYCARE Study). The habitual consumption of food contributing to calculating the PAIFIS was obtained through an FFQ and 24 h Dietary Recall (24HDR). Reliability was tested using the FFQ (FFQ1 × FFQ2), using Spearman's correlation coefficient to estimate the agreement between measurements. The validity of the PAIFIS was tested using 24HDR and the inflammatory biomarker C-reactive protein (CRP) using Spearman's correlation and multilevel linear regression.

RESULTS

For children and adolescents, pro- and anti-inflammatory food groups showed Spearman's correlation coefficients ranging from 0.31 to 0.66, convergent validity ranging from 0.09 to 0.40, and criterion validity for a reliability range from -0.03 to 0.18. The PAIFIS showed Spearman's correlation coefficients for reliability ranging from 0.61 to 0.69, convergent validity from 0.16 to 0.23, and criterion validity from -0.03 to 0.24.

CONCLUSION

The PAIFIS showed acceptable reliability, weak convergent validity, and weak criterion validity in children and adolescents.

The Hekinan Children's Study: Design and Profile of Participants at Baseline

BACKGROUND

The early life environment is now recognized as a key factor contributing to susceptibility to certain diseases in later life.

METHODS

We initiated a cohort study among school children in 2011 to primarily investigate the associations between lifestyle and environmental factors and some surrogate markers of chronic diseases, such as cardiometabolic risk factors (ie, obesity, high blood pressure, high blood glucose, insulin, or lipids) and cancer risk factors (ie, height and age at menarche). A baseline questionnaire asked for information, including demographic variables, medical history and use of medication, dietary habits, physical activity, sleep habits, and behavioral and emotional problems of children. Follow-up surveys are planned for the fourth grade of elementary school and the first grade of junior high school. At these follow-up surveys, fasting blood samples will be obtained to measure cardiometabolic markers. We also checked the validity of a food frequency questionnaire, which was originally created for 6-year-olds but was modified for use in older children.

RESULTS

A total of 3,141 first-year students at elementary schools in Hekinan City, Aichi Prefecture, participated in the study. The response rate was 87.4%. The means of age and body mass index were 6.99 (standard deviation, 0.28) years and 15.3 (standard deviation, 1.7) kg/m2, respectively, in the 3,067 Japanese children (1,639 boys and 1,428 girls).

CONCLUSIONS

This cohort will reveal determinants of cardiometabolic risk factors and cancer risk factors during childhood.

Bone Accrual in Children and Adolescent Nonelite Swimmers: A 2-Year Longitudinal Study

OBJECTIVE

To examine differences in bone mass between children and adolescents swimming competitively at nonelite levels (locally and regionally) and nonathletes and to assess changes in bone mass in these 2 groups over 24 months after taking into consideration several known confounders of bone mass.

DESIGN

Observational prospective study.

PARTICIPANTS

White nonelite swimmers (n = 128) and nonathletes (n = 106) 8 to 18 years of age from Memphis, Tennessee, USA.

MAIN OUTCOME MEASURES

Participants underwent dual-energy x-ray absorptiometry to assess total body and hip bone mineral content (BMC) at baseline and 12 and 24 months later.

RESULTS

At baseline, swimmers had 4.2% and 6.1% higher adjusted BMC for the total body and hip, respectively, compared with nonathletes (P values < 0.027). Averaging across assessment points, swimmers had 73.5 and 2.2 g higher BMC for the total body and hip, respectively, than nonathletes. Although there was a significant annual increase in total body and hip BMC in both groups (33.5 and 0.7 g, respectively), there was no difference in annualized bone accrual between swimmers and nonathletes for either total body BMC (swim by time effect; P = 0.213) or hip BMC (P = 0.265).

CONCLUSIONS

Competitive swimming at nonelite levels during childhood and adolescence does not seem to compromise bone accrual.

Assessing Initial Validity and Reliability of a Beverage Intake Questionnaire in Hispanic Preschool-Aged Children

BACKGROUND

Understanding the relationship between high-calorie beverage consumption and weight gain requires an accurate report of dietary intake. A critical need exists to develop and test the psychometrics of brief quantitative tools for minority pediatric populations.

OBJECTIVE

To modify the adult beverage intake questionnaire (BEVQ-15) for Hispanic preschool-aged children (BEVQ-PS) and test its validity and test-retest reliability in children aged 3 to 5 years.

DESIGN

Cross-sectional. The modified quantitative 12-beverage category questionnaire assessed consumption of water, fruit juice, sweetened juice drinks, whole milk, reduced-fat milk, low-fat milk, flavored milk, carbonated sweetened drinks, diet carbonated drinks, sweet tea, tea with or without artificial sweetener, and sport drinks consumed during the past month. Hispanic mothers (n=109) recruited from day-care centers provided one 4-day food intake record (FIR) and completed two BEVQ-PS surveys during a 2-week period for their preschool-aged child. Data collection was conducted through one-on-one interviews in Spanish. Validity was assessed by comparing amounts (in grams) and energy intake (in kilocalories) for each beverage category between the first BEVQ-PS and the mean of the FIRs using paired t tests and Pearson's correlation coefficient. Criteria for validity were nonsignificant mean differences in grams and kilocalories from the first BEVQ-PS and mean of the FIRs beverage categories, and significant correlation coefficients between beverage categories. Test-retest reliability was assessed by comparing grams and kilocalories for each beverage category in the first BEVQ-PS with those from the second BEVQ-PS using Pearson's correlation coefficient. The criterion for reliability was a significant correlation coefficient between beverage categories. Significance was set at P<0.05.

RESULTS

Mean differences between the first BEVQ-PS and FIR for water (42.4±23.1 g), sweetened juice drinks (-1.6±11.0 g), whole milk (18.3±9.91 g), sweetened carbonated drinks (-13.0±7.9 g), and total sugar-sweetened beverages (SSB) (1.4±8.9 g) were not significantly different, but were significantly correlated (r=0.20 to 0.37; P<0.05). Thus, validity criteria were met. With the exception of flavored milk and tea with or without artificial sweeteners, the remaining beverage categories-total beverages and SSB-in the first BEVQ-PS were correlated with those from the second BEVQ-PS (r=0.20 to 0.68; P<0.05), meeting reliability criteria.

CONCLUSIONS

Researchers and clinicians may use the BEVQ-PS to assess SSB, water, and whole-milk intake in Hispanic children. Additional modifications should be evaluated to assess total beverage intake.

Reproducibility and Relative Validity of a Short Food Frequency Questionnaire in 9-10 Year-Old Children

The aim of this study was to assess the reproducibility and validity of a non-quantitative 28-item food frequency questionnaire (FFQ). Children aged 9-10 years (n = 50) from three schools in Dunedin, New Zealand, completed the FFQ twice and a four-day estimated food diary (4DEFD) over a two-week period. Intraclass correlation coefficients (ICC) and Spearman's correlation coefficients (SCC) were used to determine reproducibility and validity of the FFQ, respectively. Weekly intakes were estimated for each food item and aggregated into 23 food items/groups. More than half of the food items/groups (52.2%) had an ICC ≥0.5. The median SCC between FFQ administrations was 0.66 (ranging from 0.40 for processed meat to 0.82 for sweets and non-dairy drinks). Cross-classification analysis between the first FFQ and 4DEFD for ranking participants into thirds showed that breakfast cereals had the highest agreement (54.0%) and pasta the lowest (34.0%). In validity analyses, 70% of food items/groups had a SCC ≥0.3. Results indicate that the FFQ is a useful tool for ranking children according to food items/groups intake. The low respondent burden and relative simplicity of the FFQ makes it suitable for use in large cohort studies of 9-10 year-old children in New Zealand.

Relative Validity of Three Food Frequency Questionnaires for Assessing Dietary Intakes of Guatemalan Schoolchildren

Objective

To determine the relative validity of three food frequency questionnaires (FFQs) compared with results from 24-hour dietary recalls for measuring dietary intakes in Guatemalan schoolchildren.

Design

A cross-sectional study of primary caregivers (mothers or grandmothers) of 6–11 year-old children. Caregivers completed one of three constructed FFQs to measure the child’s dietary consumption in the last week: FFQ1 did not incorporate portion sizes; FFQ2 provided portion sizes; and FFQ3 incorporated pictures of median portion sizes. During the same week, each caregiver also completed three 24-hour dietary recalls. Results from the FFQ were compared with corresponding results from the 24-hour dietary recalls.

Setting

Santa Catarina Pinula, peri-urban Guatemala City.

Subjects

Caregivers (n = 145) of 6–11 year-old children: 46 completed FFQ1, 49 completed FFQ2, and 50 completed FFQ3.

Results

The mean values for all nutrients obtained from the 24-hour dietary recall were lower than for those obtained from the FFQs, excluding folic acid in FFQ3, cholesterol and zinc in FFQ2, and cholesterol, folic acid, magnesium, potassium, sodium, and zinc in FFQ1. Energy-adjusted Pearson correlation coefficients ranged from 0.07 (protein) to 0.54 (cholesterol) for FFQ1 and from 0.05 to 0.74 for FFQ2 and FFQ3. Agreement by both methods (FFQ and 24-hour dietary recalls) of classifying children into the same or adjacent quartiles of energy-adjusted nutrient consumption ranged from 62.0% for cholesterol to 95.9% for vitamin B12 across all three FFQs.

Conclusions

Our FFQs had moderate to good relative validity in measuring energy and nutrient intakes for 6–11 year-old Guatemalan children. More evidence is needed to evaluate their reproducibility and applicability in similar populations.

Two facets of stress and indirect effects on child diet through emotion-driven eating

OBJECTIVE

Stress has been associated with high-calorie, low-nutrient food intake (HCLN) and emotion-driven eating (EDE). However, effects on healthy food intake remain unknown. This study examined two facets of stress (self-efficacy, perceived helplessness) and food consumption, mediated by EDE.

METHODS

Cross-sectional data from fourth-graders (n=978; 52% female, 28% Hispanic) in an obesity intervention used self-report to assess self-efficacy, helplessness, EDE, fruit/vegetable (FV) intake, and high-calorie/low-nutrient (HCLN) food.

RESULTS

Higher stress self-efficacy was associated with higher FV intake, β=.354, p<0.001, and stress perceived helplessness had an indirect effect on HCLN intake through emotion-driven eating, indirect effect=.094, p<0.001; χ(2)(347)=659.930, p<0.001, CFI=0.940, TLI=0.930, RMSEA=0.030, p=1.00, adjusting for gender, ethnicity, BMI z-score, and program group.

CONCLUSIONS AND IMPLICATIONS

Stress self-efficacy may be more important for healthy food intake and perceived helplessness may indicate emotion-driven eating and unhealthy snack food intake. Obesity prevention programs may consider teaching stress management techniques to avoid emotion-driven eating.

Relative validity and reproducibility of a brief-type self-administered diet history questionnaire for Japanese children aged 3-6 years: application of a questionnaire established for adults in preschool children

Background

Dietary intake assessment and subsequent dietary education or intervention in young children is important in decreasing prevalence of various noncontagious diseases in adulthood. Validation of diet assessment questionnaires for preschool children has just started in Japan. In this study, we rearranged the brief-type self-administered diet history questionnaire (BDHQ), a convenient diet assessment questionnaire that is widely used in a range of situations for adults, for use in children aged 3–6 years (BDHQ3y) and then validated the BDHQ3y in Japanese children.

Methods

The guardians of 61 children aged 3–4 years completed the BDHQ3y twice at an interval of 1 month, along with a 3-nonconsecutive-day diet record (DR) between the two administrations of the BDHQ3y. Dietary intakes for energy and 42 selected nutrients were estimated using both the DR and the BDHQ3y. Mean intakes estimated by the two methods were compared, and correlation coefficients were calculated. Reproducibility of the BDHQ3y estimates was investigated using intra-class correlation coefficients (ICCs).

Results

No significant differences in mean intakes estimated by the DR and the BDHQ3y were observed for one- to two-thirds of energy and examined nutrients. The median of Pearson correlation coefficients between intakes energy-adjusted by the residual method was 0.31 (interquartile range, 0.24 to 0.38). The median ICC was 0.72 (interquartile range, 0.63 to 0.76) for the crude nutrient intakes.

Conclusions

Although the BDHQ3y might be a good candidate for dietary intake assessment in Japanese preschool children, its validity is currently moderate to low. Shortcomings should be overcome by obtaining and utilizing more information about children’s dietary habits.

Relative validity and reproducibility of an FFQ to determine nutrient intakes of New Zealand toddlers aged 12-24 months

OBJECTIVE

The study objective was to determine the relative validity and reproducibility of a modified FFQ for ranking the nutrient intakes of New Zealand toddlers aged 12-24 months.

DESIGN

Cross-sectional study.

SETTING

Dunedin, New Zealand.

SUBJECTS

One hundred and fifty-two participants completed a ninety-five-item FFQ twice, and five days of weighed diet recording (WDR), over one month. Validity and reproducibility were assessed for crude data and for data that were weighted for total fruit and vegetable intake (FV-adjusted).

RESULTS

De-attenuated correlations between FV-adjusted FFQ data and WDR data ranged from 0.45 (Zn) to 0.77 (Ca). The percentage classified to the correct WDR quartile by the FV-adjusted FFQ data ranged from 34.6% (total fat, Zn) to 50.3% (Fe). Average gross misclassification was 3%. Bland-Altman statistics showed crude data had a range of 128-178% agreement with the WDR and mean FV-adjusted intakes had 112-160% agreement. FV-adjusted intra-class correlations, assessing reproducibility, ranged from 0.65 (vitamin C) to 0.75 (Ca).

CONCLUSIONS

The Eating Assessment in Toddlers (EAT) FFQ showed acceptable to good relative validity, and good reproducibility, for ranking participants' nutrient intake and is able to identify toddlers at extremes of the nutrient intake distribution. It will be a useful tool for investigating toddlers' nutrient intakes in studies that require a method of dietary assessment with low respondent burden.

Relative validity of an FFQ for pre-school children in the mother–child ‘Rhea’ birth cohort in Crete, Greece

Objective

To examine the relative validity of an FFQ based on parental report for pre-school children in the mother–child ‘Rhea’ birth cohort.

Design

The children’s mothers completed an FFQ that referred to the children’s dietary intake for the previous year by telephone interview. Mothers completed also three food records, two on weekdays and one on a weekend day. Spearman correlation coefficients were calculated for the energy-adjusted values. Weighted kappa statistics (κw) and the Bland–Altman technique were used to test the degree of agreement between the two dietary methods.

Setting

Heraklion, Crete, Greece, 2011–2012.

Subjects

A total of ninety-nine mothers (corresponding to fifty-one boys and forty-eight girls) participated in the validation study.

Results

The mean and median values of all food group and nutrient intakes did not differ significantly between the two dietary methods. Overall, fair agreement was observed between the FFQ and the food records for ranking participants based on their intake, with κw ranging from 0·21 to 0·40 for most foods and nutrients. On average, 88 % of participants were classified into the same or adjacent tertiles for nutrient and food group intakes by both dietary methods. The degree of agreement was also confirmed by the visual examination of the Bland–Altman plots.

Conclusions

The study indicates that the Rhea 4 years FFQ is a relatively accurate tool for assessing habitual food group and nutrient intakes among pre-school children in Crete, Greece.

Nutritional and safety outcomes from an open-label micronutrient intervention for pediatric bipolar spectrum disorders

OBJECTIVE

The purpose of this study was to report the safety, tolerability, and serum micronutrient concentrations and their correlations with mood changes from an 8 week pilot feasibility study of a 36 ingredient multinutrient supplement, EMPowerplus (EMP+), for pediatric bipolar spectrum disorders (BPSD).

METHODS

Ten children ages 6-12 received EMP+ escalating from one to four capsules t.i.d., with four children increased to the maximum suggested dose, five capsules t.i.d. Outcome measures were micronutrient concentrations in serum and red blood cells, vital signs, body mass index (BMI), dietary intake (Food Frequency Questionnaire and 24 hour dietary recall interview), and mood and global functioning ratings.

RESULTS

Seven children (70%) completed the study. Three (30%) terminated early for tolerability and compliance issues. Adverse effects were mild and transient, and chiefly consisted of initial insomnia or gastrointestinal (GI) upset. No differences occurred in BMI (p = 0.310) or waist-hip ratio (WHR; p = 0.674) pre- to postsupplementation. Four of the tested serum vitamin concentrations increased from pre- to postsupplementation: vitamin A-retinol, vitamin B6, vitamin E-α-tocopherol; and folate (all p<0.05). The increase in serum 25-OH vitamin D approached significance (p = 0.063). No differences were found in dietary intake pre- to postsupplementation, suggesting that blood nutrient level increases were caused by EMP+.

CONCLUSIONS

In this open prospective study, short-term use of EMP+ in children with BPSD appeared safe and well-tolerated, with a side effect profile preferable to first-line psychotropic drugs for pediatric bipolar spectrum disorders. A double-blind, randomized clinical trial is feasible, appears safe, and is warranted by open-label clinical outcomes and plausible mechanisms of action, combined with documentation of increased serum concentrations of specific micronutrients.

Assessment of nutrient intakes of picky-eating Chinese preschoolers using a modified food frequency questionnaire

BACKGROUND

Dietary assessment is crucial for monitoring nutritional status of young children. This study applied a modified Chinese food frequency questionnaire (FFQ) to assess nutrient intakes of young picky-eating Hong Kong children.

METHODS

Nutrient intakes were obtained by FFQ and 3-day food record (3DFR) in 29 picky-eating children aged 44.8±9.2 months who participated in a randomised controlled trial of a new milk formula.

RESULTS

When compared with 3DFR, FFQ over-reported energy intake by 283 kcal (26.5%) at baseline and 237 kcal (21.4%) at end-of-study, and also overestimated intakes of carbohydrates, proteins and fats. At baseline, FFQ and 3DFR classified 34.4%-65.5% of subjects into the same tertiles for most nutrients. These methods showed weak-to-moderate agreement in measuring most nutrients, with 3DFR showing a trend towards a systematic increase in the differences with increasing nutrient intake.

CONCLUSION

Our FFQ shows promising results for assessing nutrient intakes in picky-eating Chinese preschoolers.

Validity and reproducibility of food frequency questionnaire in Japanese children aged 6 years

The aim of the present study was to evaluate the validity and reproducibility of a food frequency questionnaire (FFQ) for use among young Japanese children. Forty-seven mothers of children aged 6 y completed two 3-d diet records and two FFQs over a 6-mo period. The FFQ asked the mothers how often, on average, their children consumed each of the 162 food items listed and what the usual serving size of each item was during the 6 mo prior to the study. Intakes of macro- and micronutrients were estimated by multiplying the frequency by the serving size for each food item. The validity of the FFQ was assessed by comparison of the two 3-d diet records. The reproducibility of the FFQ was based on the first and second FFQ administrations. The validity correlation ranged from 0.05 for α-tocopherol to 0.59 for retinol. The median correlation was 0.40. The reproducibility correlation was higher than 0.50 for all nutrients. For most nutrients, FFQ had acceptable reproducibility, whereas validity showed low to moderate correlations. Our FFQ could reasonably rank individuals according to dietary intake for epidemiologic studies, although the validity of the questionnaire is limited to specific nutrients.

Comparison of nutritional intake in US adolescent swimmers and non-athletes

Swimming is a very popular sport among adolescents in the US. Little is known about the diet of competitive adolescent swimmers in the US but data from other countries indicate several inadequacies, including excessive intake of fat and lower than recommended intake of carbohydrate and several micronutrients that may affect athletic performance and bone accrual. We assessed usual diet, using a food frequency questionnaire and calcium checklist, among 191 adolescent males and females [91 swimmers (mean 13.7, s = 2.5 years) and 100 non-athletes (mean 14.4, s = 2.8 years)]. For both males and females, swimmers and non-athletes generally had similar average intakes of macro- and micro-nutrients, including higher than recommended amounts of total fat (36%) and saturated fat (12%), and inadequate amounts of calcium, vitamin D, and daily servings of fruits, vegetables, grains, and dairy products. This first study of nutritional intake among adolescent swimmers in the US suggests that dietary habits of adolescents who swim competitively may jeopardize optimal athletic performance and place them at risk for future chronic diseases, including osteoporosis.

Glycaemic index and body fat distribution in children: the results of the ARCA project

BACKGROUND AND AIMS

Various dietary factors may play a critical role in body weight regulation. Among them, the role of glycaemic index (GI) remains a subject of debate. The present study aimed at evaluating the association between dietary GI, body mass index (BMI) and body fat distribution in school children.

METHODS AND RESULTS

3734 Italian children (M/F = 1883/1851; age range 6-11 years) were cross-sectionally screened for anthropometry (BMI, waist circumference), lifestyle and clinical history (questionnaire) and dietary habits (1-year food frequency questionnaire). Energy and macronutrients intake, dietary GI and glycaemic load (GL) were calculated. GI was directly associated with age, waist and BMI z-scores, energy, fibre and carbohydrate intake (r: from 0.080 to 0.238, P < 0.001), and negatively with fat intake (r: -0.060, P < 0.0001). BMI, waist circumference, energy intake, carbohydrate, protein and fibre intake and GL significantly increased, whilst fat intake decreased, going up across quartiles of residuals of dietary GI. At linear regression analysis, GI was associated with BMI and waist z-scores independently of age, sex, parental overweight/obesity, parental education, and energy intake, protein, fat, carbohydrate, fibre and GL residuals. In particular, GI was the sole nutritional factor among those under investigation, significantly associated with waist circumference. Controlling for covariates, the risk of overweight/obesity or of central fat distribution was almost two-folds higher in the upper quartile in comparison to the lowest quartile of dietary GI.

CONCLUSION

Dietary GI is an independent determinant of body fat distribution in children as well as of total adiposity.

Reproducibility and validity of the food frequency questionnaire for estimating habitual dietary intake in children and adolescents

BACKGROUND

A previous study reported the development a 75-item food frequency questionnaire for Japanese children (CFFQ). The first aim was to examine the reproducibility and validity of the CFFQ in order to assess dietary intake among two groups; 3-11 year old children (YC group) and 12-16 year old children (AD group). The second aim was to use the CFFQ and the FFQ for adults (AFFQ), and to determine which was better suited for assessing the intake of children in each group.

METHODS

A total of the 103 children participated in this study. The interval between the first CFFQ and AFFQ and the second CFFQ and AFFQ was one month. Four weighted dietary records (WDRs) were conducted once a week. Pearson's correlation coefficients between the first and second FFQs were calculated to test the reproducibility of each FFQ. Pearson's correlation coefficients between WDRs and the second FFQ were calculated for the unadjusted value and sex-, age-, and energy-adjusted values to determine the validity of each FFQ.

RESULTS

The final number of subjects participating in the analysis was 89. The median correlation coefficients between the first and second CFFQs and AFFQs were 0.76 and 0.73, respectively. There was some over/underestimation of nutrients in the CFFQ of the YC group and in the AFFQ of the AD group. The medians of the sex-, age-, and energy-adjusted correlation coefficients were not different between the YC and AD groups for each FFQ. The correlation coefficient in sex-, age-, and energy-adjusted value revealed that the largest number of subject with high (0.50 or more) value was obtained by the CFFQ in the YC group.

CONCLUSIONS

This study indicated that the CFFQ might be a useful tool for assessing habitual dietary intake of children in the YC group. Although the CFFQ agreed moderately with habitual intake, it was found to underestimate intake in theAD group. However, for the AFFQ, the ability to rank habitual intake was low. Therefore, it is necessary to develop a new FFQ or modify an existing FFQ to accurately assess the habitual diet of children in the AD group.

Adaptation and validation of an FFQ for 6-10-year-old children

OBJECTIVE

To adapt and test the relative validity of an instrument measuring the usual food intake of 6-10-year-old children.

DESIGN

An FFQ encompassing the preceding 6 months was adapted and compared with the average of three 24 h dietary recalls.

SETTING

Private and public schools in Porto Alegre, capital city of Rio Grande do Sul, the southernmost state in Brazil, with 1·5 million inhabitants.

SUBJECTS

Children aged 6-10 years attending grades 1-4 in private and public schools in Porto Alegre.

RESULTS

Ninety-one children were studied. The FFQ overestimated all nutrients. Correlations with the values obtained by 24 h dietary recalls were mostly above 0·50. The deattenuated correlations increased for all nutrients. The κ coefficients for the adjusted nutrients varied from 0·12 (weak) to 0·34 (reasonable). Graphically, the FFQ was shown to underestimate some of the parameters and to overestimate others, with a wide CI for all nutrients.

CONCLUSIONS

The FFQ does not have the required relative validity to classify the intake levels of schoolchildren, and further investigation is required to understand the sources of error.

Fat intake and asthma in Spanish schoolchildren

OBJECTIVES

To study the relationship between lipid, fatty acid and lipid-rich food intake and current asthma in a group of Spanish schoolchildren.

SUBJECTS/METHODS

The subjects of this cross-sectional study were 638 Spanish schoolchildren (8-13 years of age). The weight and height of all the subjects were recorded. A questionnaire, completed by the subjects' parents, was used to obtain personal and health information. Current asthma was established when the children had ever had asthma, if they had been diagnosed with asthma by a doctor and if they had been treated with medications at some time in the previous 12 months. Food intake was monitored using a 3-day food record. All foods consumed were converted into energy and nutrients.

RESULTS

The energy derived from lipids, saturated fatty acids (SFAs) and myristic and palmitic acids was independently associated with current asthma (Odds Ratio (OR) third tertile 2.85 (1.01-8.07) P=0.049, 10.00 (0.89-111.97) P=0.002, 11.21 (1.36-92.24) P=0.002, 7.58 (1.40-41.03) P=0.022, respectively), as was the intake of butter (OR third tertile 2.97 (1.01-8.68) P=0.001). No relationship was seen between this condition and the intake of any other fatty acid, the n-6/n-3 ratio, nor the consumption of margarine, milk products, fish, meat, eggs or vegetable oils.

CONCLUSIONS

Increased intakes of SFAs, myristic and palmitic acids and butter seem to be related to the risk of current asthma in children.

Development of a food frequency questionnaire to estimate habitual dietary intake in Japanese children

BACKGROUND

Food frequency questionnaires (FFQ) are used for epidemiological studies. Because of the wide variations in dietary habits within different populations, a FFQ must be developed to suit the specific group. To date, no FFQ has been developed for Japanese children. In this study, we developed a FFQ to assess the regular dietary intake of Japanese children. The FFQ included questions regarding both individual food items and mixed dishes.

METHODS

Children (3-11 years of age, n = 621) were recruited as subjects. Their parents or guardians completed a weighed dietary record (WDR) for each subject in one day. We defined FOOD to be not only as a single food item but also as a mixed dish. The dieticians conceptually grouped similar FOODs as FOOD types. We used a contribution analysis and a multiple regression analysis to select FOOD types.

RESULTS

We obtained a total of 586 children's dietary data (297 boys and 289 girls). In addition, we obtained 1,043 FOODs. Dieticians grouped into similar FOODs, yielding 275 FOOD types. A total of 115 FOOD types were chosen using a contribution analysis and a multiple regression analysis, then we excluded overlapping items. FOOD types that were eaten by fewer than 15 subjects were excluded; 74 FOOD types remained. We also added liver-based dishes that provided a high amount of retinol. A total of 75 FOOD types were finally determined for the FFQ. The frequency response formats were classified into four type categories: seven, eight, nine and eleven, according to the general intake frequency of each FOOD type. Information on portion size was obtained from the photographs of each listed FOOD type in real scale size, which was the average amount of the children's portion sizes.

CONCLUSIONS

Using both a contribution analysis and a multiple regression analysis, we developed a 75-food item questionnaire from the study involving 586 children. The next step will involve the verification of FFQ reproducibility and validity.

Energy and macronutrient intakes in preschool children in urban areas of Ho Chi Minh City, Vietnam

BACKGROUND

An increasing prevalence of overweight and obesity has been documented in preschool children in Ho Chi Minh City (HCMC), Vietnam. However, little is known about what preschool children in HCMC eat or how well their nutrient intake meets nutrient recommendations. This study aims to describe the energy and macronutrient intake and compare these nutrient intakes with the recommendations for Vietnamese children aged four to five years.

METHODS

The data comes from the baseline measurement of a one year follow-up study on obesity in 670 children attending kindergartens in HCMC. Dietary information for each child at the school and home settings was collected using Food Frequency Questionnaires (FFQs), by interviewing teachers and parents or main caregivers. The average energy and nutrient intake in a day was calculated. The proportion of children with energy intake from macronutrients meeting or exceeding the recommendations was estimated based on the 2006 recommended daily allowance (RDA) for Vietnamese children in this age group.

RESULTS

The dietary intake of the participants contained more energy from protein and fat, particularly animal protein and fat, and less energy from carbohydrates, than the RDA. Most children (98.1%) had mean energy intake from protein greater than the recommended level of 15%, and no child obtained energy from animal fat that was in accordance with the recommendation of less than 30% of the total fat intake. Nearly one half of children (46.5%) consumed less than the advised range of mean energy intake from carbohydrate (60%-70%).

CONCLUSION

In this preschool child population in HCMC, in which obesity is emerging as major public health problem, there is an imbalance in dietary intake. Healthy eating programs need to be developed as a part of an obesity prevention program for young children in HCMC.

Validation of a food frequency questionnaire for assessing dietary nutrients in Brazilian children 5 to 10 years of age

OBJECTIVE

This study aimed to assess the relative validity of a food frequency questionnaire (FFQ), previously validated to measure usual intakes in adults, for measuring dietary intakes in children 5 to 10 y of age.

METHODS

Dietary intakes were measured using an FFQ and a 3-d dietary record. Healthy children, 5 to 10 y old (n = 151), were recruited from public schools and asked to answer the questions in the FFQ and to provide non-consecutive 3-d dietary records based on reported estimated portion sizes. Paired sample t tests and Pearson's correlation coefficients were conducted to determine whether the two instruments reported similar values for energy and nutrients. The agreement of quartile categorization between the two instruments was also examined.

RESULTS

Estimated energy and nutrient intakes derived from the FFQ were significantly higher than those derived from 3-d dietary records. As expected, Pearson's correlations increased after adjusting for residual measurement error, presumably due to exclusion of the high within-person variability in intake of these nutrients. Moderate to high (r > 0.50) correlation coefficients were verified for some nutrients such as calcium, folate, vitamin B2, vitamin A, and vitamin C.

CONCLUSION

This FFQ, originally developed for use in adults, appears to overestimate usual energy and nutrient intakes in children 5 to 10 y of age. Further work is necessary to conduct a calibration study to establish adequate portion sizes before instrument adoption in this population.

Daily calcium intake in male children and adolescents obtained from the rapid assessment method and the 24-hour recall method

BACKGROUND

In order to rapidly assess nutrient intake, Food Frequency Questionnaires (FFQ) have been developed and proven to be reliable for quick, user friendly analysis in adults. However, the accuracy of these questionnaires in children has been studied to a limited extent. The aim of this study was to compare the daily calcium intake values obtained from the Rapid Assessment Method (RAM), an FFQ, for assessing daily calcium intake in child and adolescent males with the values obtained from the 24-hour recall method.

METHODS

Subjects included 162 child and adolescent males, aged 9-16 years, subdivided into elementary school (ES, 9-12 years) and high school (HS, 14-16 years) age groups.

RESULTS

Daily calcium intake was significantly lower in ES compared with HS, using both methods. The intra-class correlation coefficients (ICC) between RAM values and those obtained using the 24-hour recall questionnaire were significant yet moderate (ICC = 0.46 and 0.43 for ES and HS, respectively). However, daily calcium intake obtained using RAM was significantly higher when compared with the 24-hour recall values in both ES (1576 +/- 1101 vs. 1003 +/- 543 mg, in RAM and 24-hour, respectively) and in HS males (1873 +/- 739 vs. 1159 +/- 515 mg, in RAM and 24-hour, respectively).

CONCLUSION

RAM overestimates daily calcium intake as compared with the 24-hour recall method in both child and adolescent males.

Validity and reproducibility of a semi-quantitative food-frequency questionnaire for estimating calcium intake in Belgian preschool children

Relative validity and reproducibility of a semi-quantitative food-frequency questionnaire (FFQ) for measuring preschool children's usual Ca intake were assessed using parents or guardians as a proxy. Estimated diet records (EDR; 3d) were used as the reference method and reproducibility was measured by repeated FFQ administrations 5 weeks apart. From 2095 preschool children (2·5–6·5 years) randomly selected in Flanders (Flemish region of Belgium), 1052 returned a FFQ and EDR. Stringent exclusion procedures reduced the sample for validity analyses to 509 children. From a separate sample of 244 preschool children, 124 returned two FFQ, of whom sixty were included in the reproducibility analysis. Mean Ca intakes were 838 (sd 305) and 777 (sd 296) mg/d for EDR and FFQ respectively, indicating a mean difference of 60·9 (sd 294·4) mg/d (p<0·001). Pearson's correlation was 0·52. Cross-classification analysis of the FFQ and EDR classified 83%of the subjects in the same or adjacent category and 2·4% in extreme quartiles. Actual values for surrogate FFQ quartiles showed a progressive increase in Ca intake (p<0·001). The FFQ correctly identified 77% of the children consuming less Ca than the age-specific RDA (800mg/d). Correlation between repeated administrations was 0·79. No significant difference between mean Ca intakes was established by two administrations (23·8 (sd 161·2) mg/d). Cross-classification of repeated administrations classified 93·4% of the subjects in the same or adjacent category and no subjects in extreme categories. This FFQ tended to underestimate preschool children's Ca intake when administered by a proxy. However, it demonstrated good repeatability and fairly good ability to classify subjects into extremes of Ca intake.

Relative validation of a pre-coded food diary among children, under-reporting varies with reporting day and time of the day

OBJECTIVE

The aim of this study was to validate intake of energy, macro- and micronutrients assessed from pre-coded food diaries (PFDs) by using weighed records (WRs) as the reference method among a group of Norwegian 9-year-olds. We also examined how under-reporters (UR) differed from acceptable reporters (AR) according to the energy intake during the 4-day recording period and energy intake distribution during the day.

SUBJECTS AND DESIGN

One hundred 9-year-olds, 45 girls and 55 boys, were recruited to complete a 4-day record with a PFD followed 3 days later with a 4-day WR.

RESULTS

There were no differences between energy and nutrient intake from the two recording methods among boys, but girls reported significantly higher intakes with PFD compared with WR. The median Spearman correlation coefficient between PFD and WR for energy and nutrients was 0.43 for girls and 0.49 for boys. Twelve participants were classified as UR with the PDF method. Energy percentages from macronutrients were not significantly different between UR and AR with the PFD method. UR had significantly lower energy intake in the last two recording days and from 1000 to 2200 hours during the day compared to AR.

CONCLUSIONS

The PFD method is promising as a tool for assessing food intake in large surveys among children. The present study indicates that the PFD gives more valid data for boys than girls according to the group intake and ranking of nutrient intake when WR is the reference method. However, UR seemed to develop a study fatigue during the day and during the recording period. Increased awareness about the tendency of study fatigue can lead to more specific instructions on how participants can handle the problem.